This invention, in general, relates to a health plan organization. More particularly, this invention relates to automating business processes of the health plan organization.
Health plan organizations provide health care and health insurance coverage to a consumer. There are various business processes involved in the functioning of a health plan organization. These business processes involve many interactions between the departments of the health plan organization. The departments within a health plan organization may include, but not limited to, a marketing department, a sales department, a finance department, an underwriting department, and a customer services department. The business processes of each of these departments require manual intervention by brokers, sales representatives, underwriters, administrators, and customer service representatives. The activities of the departments including generating health plan proposals and insurance quotes, enrolling consumers for various health plans, underwriting, tracking of payments etc., would therefore be time consuming and may lead to inefficiency of the business processes. Therefore, there is a need for increasing efficiency of the business processes of the health plan organization and also integrating the business processes within the health plan organization in order to improve the quality of the health plans.
Moreover, the business processes in the health plan organization need to adhere to certain compliancy standards defined by the Health Insurance Portability and Accountability Act (HIPAA). These compliancy standards ensure privacy of consumer health information, secure electronic transactions, and simplified administration of the various business processes in the health plan organization. The HIPAA requires compliancy of standards for transactions such as enrollment, eligibility or benefit inquiries, referral certification and authorization, payment of premiums, etc.
Hence, there is a need for a computer implemented method and system for automating the business processes in a health plan organization and improving the efficiency of transactions between various departments of a health plan organization to improve the quality of the heath plans.